| NPI | 1710182092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 64787-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A130775) |
| 208D00000X General Practice (Licence: IN 01065555A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2022-07-21 |